Effects Of Intracoronary Diltiazem On Coronary No Reflow Penomenon During Emergency Percutaneous Coronary Intervention

Objective:The purpose of this paper was to study the effects of intracoronary diltiazem on coronary no reflow(NR) phenomenon after dilatation with balloon for the infarct-related artery during emergency percutaneous coronary intervention for acute ST elevation myocardial infarction(STEMI),and evaluate the safety.Methods:1 To select a total of 70 consecutive patients who were first diagnosde clearly as acute STEMI and received the PCI in the Department of Vasculocardiology,Third Hospital of Hebei Medical University from February 2013 to November 2014.These patients who combined with hypotension,cardiogenic shock,acute serious heart failure,serious liver or kidney function incompetence and so on were excluded.All patients were randomly divided into two groups after signing informed consent forms: in the experimental group who intracoronary diltiazem after dilatation with balloon for the infartion related artery(n=36),23 cases(63.89%)of man,with an average age of 58.89±9.11 years old, and in the control group who intracoronary normal saline at the same time, 22 cases(64.71%)of man,with an average age of 60.06±10.02 years old(n=34).2 All patients in the two groups were given aspirin 300 mg,clopidogrel 600 mg and atorvastatin 40 mg befor the opration,and given nitroglycerin 200 ug,heparin sodium(100U/kg) during the opration,and given tirofiban or/and nitroprusside in the opration according to the condition,the patients who combinded with hypotension were given dopamine,all patients were given aspirin100 mg 1/day, clopidogrel 75 mg 1/day,atorvastatin 20 mg 1/day in hospital, low-molecular heparin(4250 U,Q12h) was hypodermic injection from 6h after operation to 7days,then given the basic treatment with other medicines according to the blood pressure and heart rate,such as calcium channel blockers, angiotensin converting enzyme inhibitor/angiotensin receotor blockers(ACEI/ARB),and beta receptor blockers.3 To record the baseline characteristics of all patients:such as age,gender,smoking,family history,mean blood pressure,heart rate, the basic diseases combined with(such as hypertension,diabetes, and blood lipid metabolic abnormalities), the grade of killip,the time to see a doctor,door to balloon time.The data of coronary angiography:the number of damaged vessels,infarct-related artery,the number of stents,the number of patients with post-dilatation,the TIMI(thrombolysis in myocardial infarction)flow grade,TMPG(TIMI myocardial perfusion grade).The mean blood pressure,heart rate after operation,the ST-segment resolution(STR≥)70% in 90 minutes after operat,the left ventricle ejection fraction(LVEF) in 7 days after the PCI,the rate of major adverse cardial events in hospital and follow-up within 90 days.4 Statistical Analysis:All the data was analysed by the SPSS20.0 software,the measurement data was expressed with mean ±standerd deviation,differences between two groups of the data were examined by t-test,the enumeration data which expressed by percentage were examined by chi-square test,ranked data were examined by rank sum test,the differences were statistically significant when P<0.05.Results:1 There were no statistically significant between the two groups in the baseline characteristics: the age,gender,smoking,family history,mean blood pressure,heart rate, the basic diseases combined with(such as hypertension,diabetes,and blood lipid metabolic abnormalities), the grade of Killip,the time to see a doctor,door to balloon time,the number of damaged vessels,infarct-related artery,the number of stents,the number of patients with post-dilatation(P>0.05).2 The infarct-related artery of those 70 patients with emergency PCI was all opened successfully. The patients with IRA forward flow reaches TIMI grade three after the stent implantation,32 cases in the experimental group(88.89%),24 cases in the control group(70.59%). Compared with the control group,the experimental group had an obvious higher rate of TMPG(TIMI myocardial perfusion grade) three after PCI(83.33%vs64.71, P=0.034)and an obvious lower rate of the no reflow after PCI(11.11%vs29.41%),differences were considered statistically significant(P=0.048).3 The experimental group had an obvious higher STR(STR≥70%)than the control group at 90 minutes after the operation(66.67%vs41.18%),differences were considered statistically significant(P=0.032).4 Compared with the control group,the experimental group had an obviously higher LVEF at 7 days after PCI in the experimental group(54.59±12.51%vs48.53±10.45%,P=0.032),the differences were considered statistically significant.5 There were no significant differences between the two groups in the mean blood pressure, heart rate after PCI, the incidence rate of MACE in hospital and follow-up within 90days(P>0.05).Conclusion: For the patients with acute STEMI undergoing emergency PCI,the intracoronary diltiazem after the IRA dilated with balloon,which can improve the blood perfusion for infarction muocardial partly, reduce the incidence rate of the no reflow phenomenon,improve the left ventricular function, without impacting the heart rate and blood pressure,and without increasing the incidence rate of MACE in hospital and follow-up within 90 days.